Ischaemic Heart Disease: Coronary Revascularisation

Question 1

List the types of coronary revascularisation

Answer 1

• Coronary Artery Bypass Graft (CABG)

- Percutaneous Coronary Intervention (PCI) (angioplasty)

Question 2

Describe the basic process of a CABG

Answer 2

median sternotomy
-->
Patient put on cardiopulmonary bypass
-->
Cardioplegia
-->
saphenous vein or internal mammary artery grafted

Question 3

Is the saphenous vein or internal mammary artery prefered for CABGs?

Why?

Answer 3

Internal mammary artery is prefered as is takes longer to redevelop disease

Question 4

How long do CABGs usually last?

Answer 4

8-10 years

Question 5

List the possible complications of CABG

Answer 5

• Death
• Stroke
• MI
• Atrial Fibrillation
• Infection
• Sternal malunion
• Renal failure
• Brain damage

Question 6

Describe the basic process of a PCI

Answer 6

Access to the radial artery
–>
Anti-platelet and anticoagulant drugs given
–>
Catheter fed through arteries to the ascending aorta
–>
Guidewire guides balloon (and stent if present) into position
–>
Balloon expands (fixing stent if present)

Question 7

List the possible complications of a PCI

Answer 7

• Death
• Stroke
• MI
• Renal damage (contrast nephropathy)
• Hematoma
• Stent fails (can happen in many ways)

Question 8

Which has a greater risk of complications, PCI or CABG?

Answer 8

CABG is more likely to have complications

Question 9

Why is the radial artery used as vascular access for angioplasty?

Answer 9

• The hand has collateral circulation
• Its superficial
• No adjacent nerve or vein
• Can compress it against the bone

However:
- it is more prone to occlusion and spasm

Question 10

Can angioplasty follow right after angiography?

Answer 10

Yes

Question 11

List ways in which stents can fail

Answer 11

• failure to deliver
• failure to expand
• perforation on expansion
• Stent thrombosis
• Stent restenosis
• doesn’t cover all the atherosclerosis

Question 12

Define restinoses

Answer 12

Recurrence of narrowing of an artery or valve after corrective surgery

Question 13

Describe cardioplegia

Answer 13

The intentional and temporary cessation of cardiac activity for cardiac surgery

Question 14

Describe cardiopulmonary bypass

Answer 14

A bypass machine takes over the function of the heart and lungs during surgery

It maintains the circulation of blood and oxygen in the patient’s body

Question 15

In the treatment of MIs is thrombolysis or angioplasty better?

Answer 15

Angioplasty (PCI) is better as it has a better:

• mortality rate
• complications rate

Question 16

Is revascularization cost effective?

Answer 16

Yes, very

Question 17

When is revascularization used in STEMIs?

What type is used?

Answer 17

PCI is used always

Question 18

When is revascularization used in acute coronary syndrome?

What type is used?

Answer 18

Angiography with a view
to revascularization

Usually PCI

Question 19

When is revascularization used in chronic stable angina?

What type is used?

Answer 19

Only if:

• medical treatment is not working
• very severe symptoms
• very high risk

CABG or PCI

Question 20

Generally is PCI or CABG preferred?

Answer 20

PCI

Question 21

List different types of PCI

Answer 21

• Balloon angioplasty (w/o stent)

- Balloon angioplasty (with a stent)